Mood stabilisers

This factsheet gives information about medication that can stabilise the
highs and lows of your mood. These are often known as mood stabilisers.

• You may get mood swings if you have some mental illnesses,
including bipolar disorder (previously called manic depression),
schizoaffective disorder and personality disorder.
• Mood swings can mean that you have high moods (mania) and low
moods (depression). If you have a mood disorder, you may be
given mood stabilising medication which evens out the highs and
the lows of your mood.
• There are different types of medication that can help stabilise
mood.
• Everyone reacts differently to medication and there can be side
effects. Speak to your doctor about your medication if you have any
questions.

This factsheet covers:

1) What are mood stabilisers?

2) Are there different types of mood stabilisers?
3) Are there any side effects?
4) What if I want to stop taking mood stabilisers?
5) Do mood stabilisers affect other medication?
6) Does alcohol affect my mood stabiliser?
7) Can I drive when taking my mood stabiliser?
8) What else should I consider before taking mood stabilisers?
1. What are mood stabilisers?

Mood stabilisers are a type of medication that can help if you have
unhelpful moods swings such as mania, hypomania and depression They
help to control and ‘even out’ these mood swings.

Mania1
Symptoms of mania can include:

• feeling happy or excited, even if things are not going well for you,
• being full of new and exciting ideas,
• moving quickly from one idea to another,
• hearing voices that other people can’t hear,
• being more irritable than normal,
• feeling more important than usual,
• talking very quickly, jumping from one idea to another, racing
thoughts,
• being easily distracted and struggle to focus on one topic,
• being over familiar with people,
• not being able to sleep, or feel that you don’t want to sleep,
• thinking you can do much more than you actually can,
• making unusual, or big decisions without thinking them through,
and
• doing things you normally wouldn’t which can cause problems.
Such as:
o spending a lot of money,
o being more interested in sex,
o using drugs or alcohol,
o gambling or
o making unwise business decisions.

Hypomania
Hypomania is like mania but you will have milder symptoms. Treatment for
hypomania is similar to the treatment for mania.2

Depression3
Symptoms of depression can include:

• low mood,
• having less energy and feeling tired,
• feeling hopeless or negative,
• feeling guilty, worthless or helpless,
• being less interested in things you normally like doing or enjoying
them less,
• difficulty concentrating, remembering or making decisions,
• feeling restless or irritable,
• sleeping too much or not being able to sleep,
• feeling more or less hungry than usual,
• losing or gaining weight, when you do not mean to, and
• thoughts of death or suicide, or suicide attempts.
Your mood may change quickly between mania and depression.

Your doctor may prescribe mood stabilisers if you have an episode of

mania, hypomania or depression that changes or gets worse suddenly.
This is called an acute episode. Some people need to take mood
stabilisers as a long-term treatment to stop this from happening.
You may experience mania or depression if you have a condition such as
bipolar disorder, schizoaffective disorder, depression or personality
disorder.

You can find more information about:

• Bipolar disorder
• Schizoaffective disorder
• Depression
• Personality disorder
at www.rethink.org. Or call our General Enquiries team on 0121 522 7007
and ask them to send you a copy of our factsheet.

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2. Are there different types of mood stabilisers?

There are different types of medication that can help stabilise your mood.
The National Institute of Health and Care Excellence (NICE) produce
guidelines for the assessment and treatment of mental
illnesses, such as bipolar disorder and schizoaffective disorder. Your doctor
should use these guidelines to decide which medication to offer you. You can find
these in the further reading section below.

The most common mood stabilisers are listed below.

Lithium
Lithium is used for the long-term treatment of mania. It can reduce how
often you get an episode and how severe they are.4 It has been found to
reduce the risk of suicide.5

NICE guidance for bipolar disorder recommends lithium as a first choice to

treat episodes of mania and also for long-term treatment. 6

To make sure that the lithium is working properly and is not at a

dangerous level, you should have tests to check the lithium levels in your
blood every 3 to 6 months.7 Your doctor may give you a booklet to keep a
record of your lithium levels.

Lithium comes in 2 forms. A tablet and a liquid.

The tablets are made from lithium carbonate. There are different brand
names for the tablets. Some of these are:8

• Camcolit,
• Priadel, and
 • Liskonum.

The liquid is made from lithium citrate. The main brand names for the
liquid are:9

• Priadel liquid, and

• Li-liquid.

Valproate
NICE guidance for bipolar disorder recommends valproate to treat
episodes of mania and also for long-term treatment. Especially if lithium
has not worked or is unsuitable. 10

Valproate is a medication used to treat epilepsy. But it is also used to treat

mania.11 There are different forms of valproate. Valproic acid comes in the
form of tablets and capsules. The main brand names for valproic acid
are:12

• Belvo
• Depakote, and
• Convulex.

Sodium valproate can be given by injection, tablets and granules. The

main brand name for sodium valproate are:13

• Episenta, and
• Epilim.

Lamotrigine
This is sometimes called Lamictal. It is a medication used to treat epilepsy.
It can come in the form of a tablet or a dispersible tablet. Which means
that you dissolve it in water before taking it.14

It can treat bipolar disorder when depression is the main problem.15 NICE
guidance does not recommend it to treat episodes of mania, or as a first
option for long-term treatment of bipolar disorder.16

Antipsychotics
Antipsychotic medication can help to stabilise mood. This type of
medication is normally used to treat symptoms of psychosis. Symptoms of
psychosisinclude delusions, hallucinations and paranoia. Some of the
newer antipsychotics can be used to treat bipolar disorder. NICE
guidelines recommend the following antipsychotics if you have bipolar
disorder.
• Olanzapine.
• Haloperidol.
• Quetiapine.
• Respiridone.17
Can I choose my medication?

The best treatment for you will depend on your symptoms or diagnosis.
This should be based on what you, your doctor or your healthcare team
agree to.
If you do not feel you are being listened to then you could try and get help
from an advocate. An advocate can help you to make your voice heard.
They can talk to professionals to make sure you get the right help and
treatment.

You can find more information about:

• Psychosis
• Antipsychotics
• Advocacy
• Medication – Choice and managing problems
at www.rethink.org. Or call our General Enquiries team on 0121 522 7007
and ask them to send you a copy of our factsheet.

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3. Are there any side effects?

If you take mood stabilisers you may find that you get side effects. Some
side effects may only last for a short time or become easier to cope with. If
you are worried about the side effects of your medication, speak to your
doctor. Sometimes a lower dose or changing your medication will reduce
side effects.

Side effects of lithium18

Most side effects are directly related to how much lithium is in the blood
stream. These are some side effects of lithium:

• stomach pain,
• feeling sick,
• shaking,
• a metallic taste in your mouth,
• feeling thirstier and needing to pass urine more frequently, and
• weight gain.

You should get regular blood tests to make sure you have a safe level of
lithium in your blood.19

Taking lithium can change the amount of sodium in your body.20 This can
lead to higher levels of lithium which can cause poisoning.21 This can be
made worse by diarrhoea or vomiting, not drinking enough water or other
medications.22 If you would like more advice about this, speak to your
doctor.
Side effects of valproate
Valproate can cause: 23

• stomach upset and feeling sick,

• hair loss,
• memory loss,
• problems concentrating,
• headaches,
• dizziness,
• confusion,
• deafness,
• feeling sleepy,
• hallucinations, and
• tremors.

In women, valproate can cause increased testosterone levels.24 This can

lead to periods stopping and abnormal hair growth.25

Valproate may be linked to a condition called polycystic ovaries in women.

26 This can affect how the ovaries work, which can cause symptoms

including excessive body hair, irregular periods, problems getting pregnant

or acne.27

If you are pregnant, valproate can cause problems with the unborn baby. If
you are able to have children, your doctor must not prescribe you
valproate unless you are on the pregnancy prevention programme.28 See
section 8 of this factsheet for more information.

Valproate can affect how your liver works,29 so you will need regular tests.
NICE guidance says to test your liver at the start of treatment and every 6
months after that.30

Side effects of lamotrigine

Common side effects include: 31

• aggression,
• joint pain,
• becoming agitated,
• vomiting and diarrhoea,
• drowsiness,
• dizziness,
• dry mouth,
• tiredness,
• irritability,
• headaches,
• tremors, and
• sleep problems.
Side effects of antipsychotics
The side effects of antipsychotics can be different depending on which
type of antipsychotic you take.

You can find more information about ‘Antipsychotics’ at

www.rethink.org. Or call our General Enquires team on 0121 522 7007
and ask them to send you a copy of our factsheet.

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4. What if I want to stop taking mood stabilisers?

Do not stop taking your mood stabiliser without first talking to your doctor.
If you need to stop, your doctor can reduce the dose slowly over a few
weeks. You should look out for signs of your illness returning if you are
stopping your medication.32

You may get withdrawal symptoms if you stop taking your medication
suddenly. These symptoms depend on the medication you are taking.
Talk to your doctor about withdrawal symptoms before stopping your
medication.

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5. Do mood stabilisers affect other medication?

You should tell your doctor if you are taking any other medication before
starting or stopping mood stabilisers. This includes herbal or
complementary medication, such as St Johns Wort.33

There are also some common over-the-counter medications which can

cause effects, some severe, when taken with mood stabilisers. These
include:

• codeine,34
• paracetamol,35 and
• Ibuprofen.36

Your doctor can give you advice on whether your mood stabiliser will
affect any other medication.

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6. Does alcohol affect my mood stabiliser?

Alcohol is not recommended when using some mood stabilisers.

Drinking alcohol whilst taking valproate can increase your risk of liver
damage.37 And drinking alcohol whilst taking lamotrigine can affect your
ability to perform skilled tasks, such as driving.38

Your doctor should talk to you about how alcohol may affect your
medication.39
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7. Can I drive when taking mood stabilisers?

Some mood stabilisers may make you drowsy and affect your driving. Tell
the DVLA if you are taking medication that may affect your driving. You
should also tell them if you have a medical condition that could affect your
driving.

You can find out more about ‘Driving and mental illness’ at
www.rethink.org. Or call our General Enquiries team on 0121 522 7007
and ask for a copy to be sent to you.

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8. What else should I consider before taking mood stabilisers?

Sex
Medication can affect sexual desire (libido), arousal and your ability to
have an orgasm. If this happens, talk to your doctor. Changing the dose
could help with this problem.

Pregnancy
If you are thinking of trying for a baby, speak to your doctor about your
medication.

Your doctor should give you information about the effects that medications
can have during pregnancy.

If you are pregnant and need to take a mood stabiliser speak to your
doctor. Some mood stabilisers can cause problems if you take them whilst
you are pregnant. It is important that any decision about treatment during
pregnancy weighs up the individual risks and benefits.

Lithium
Taking lithium during pregnancy can cause heart problems in the foetus.40
Lithium should be not be taken when you are pregnant if possible.

Valproate41
Valproate can harm an unborn baby. It can cause birth defects such as:

• spina bifida,
• problems with forming the face and skull, and
• problems forming the limbs, heart, kidney, urinary tract and sexual
organs.

It can also cause developmental and learning problems such as:

• being late in learning to walk and talk,

• lower intelligence than other children of the same age,
 • poor speech and language skills, and
• memory problems.

Children are also more likely to have autism or autistic spectrum disorders
and signs of Attention Deficit Hyperactivity Disorder (ADHD).

Lamotrigine
NICE guidleines say that you should tell your doctor if you are pregnant
and taking lamotrigine.42

Antipsychotics
NICE guidance recommends antipsychotics that are used as mood
stabilisers are better than other mood stabilisers if you are pregnant. 43

Breast feeding
NICE guidelines recommed that antipsychotics are used as mood
stabilisers whilst breast feeding.44 Speak to your doctor about this.

1 Avon and Wiltshire Mental Health Partnership NHS Trust – Mania and hypomania.
www.awp.nhs.uk/advice-support/conditions/hypomania-and-mania/ (Accessed 7th
January 2020).
2 Avon and Wiltshire Mental Health Partnership NHS Trust – Mania and hypomania.

www.awp.nhs.uk/advice-support/conditions/hypomania-and-mania/ (Accessed 7th

January 2020).
3 NHS. Clinical depression. www.nhs.uk/conditions/clinical-depression/symptoms/

(Accessed 7th January 2020).

4 Tondo L et al. Long-term clinical effectiveness of lithium maintenance treatment in types

I and II bipolar disorders. British Journal of Psychiatry Supplement 2001; 41:s184-90

5 Kessing DE et al. Suicide risk in patients treated with lithium. Archive of General

Psychiatry 2005; 62: 860-866. Available at: DOI:10.1001/archpsyc.62.8.860 (Accessed

4th February 2020).
6 National Institute for Health and Care Excellence. Bipolar disorder: assessment and

management. Clinical Guidance 185. London: National Institute for Health and Clinical
Excellence. Para 1.7.6.
7 National Institute for Health and Care Excellence. Bipolar disorder: assessment and

management. Clinical Guidance 185. London: National Institute for Health and Clinical
Excellence. Para 1.10.19 and 1.10.20.
8 British National Formulary. Lithium carbonate. https://bnf.nice.org.uk/drug/lithium-

carbonate.html#indicationsAndDoses (Accessed 4th February 2020).

9 British National Formulary. Lithium citrate. https://bnf.nice.org.uk/drug/lithium-

citrate.html#indicationsAndDoses (Accessed 4th February 2020).

10 National Institute for Health and Care Excellence. Bipolar disorder: assessment and

management. Clinical Guidance 185. London: National Institute for Health and Clinical
Excellence. Para 1.7.6.
11 British National Formulary. Valproate https://bnf.nice.org.uk/drug/sodium-

valproate.html#indicationsAndDoses(Accessed 18 February 2020).

12 British National Formulary. Valproic acid. https://bnf.nice.org.uk/medicinal-

forms/valproic-acid.html (Accessed 4th February 2020).

13 British National Formulary. Sodium valproate. https://bnf.nice.org.uk/drug/sodium-

valproate.html#medicinalForms (Accessed 4th February 2020).

14 British National Formulary. Lamotrigine. https://bnfc.nice.org.uk/medicinal-

forms/lamotrigine.html (Accessed 10th February 2020).

15 NICE Clinical Guidance 185 para 1.6.3.
16 National Institute for Health and Care Excellence. Bipolar disorder: assessment and

management. Clinical Guidance 185. London: National Institute for Health and Clinical
Excellence. Para 1.5.10 and paras 1.7.5 – 1.7.8.
17 National Institute for Health and Care Excellence. Bipolar disorder: assessment and
management. Clinical Guidance 185. London: National Institute for Health and Clinical
Excellence. Para 1.5.3
18 British National Formulary. Lithium Carbonate.https://bnf.nice.org.uk/drug/lithium-

carbonate.html#sideEffects (accessed 18 February 2020) .

19 National Institute for Health and Care Excellence. Bipolar disorder: assessment and

management. Clinical Guidance 185. London: National Institute for Health and Clinical
Excellence. Para 1.10.19 – 1.10.20.
20 British National Formulary. Lithium Carbonate.https://bnf.nice.org.uk/drug/lithium-

carbonate.html#sideEffects (accessed 18 February 2020).

21 Dilmen ÖK, Hacı İ, Ekinci A, Bahar M. Lithium Intoxication Accompanied by

Hyponatremia. Turk J Anaesthesiol Reanim. 2016;44(4):219–221.

doi:10.5152/TJAR.2016.74317.
22 National Institute for Health and Care Excellence. Bipolar disorder: assessment and

management. Clinical Guidance 185. London: National Institute for Health and Clinical
Excellence. Para 1.10.17 – 1.18.
23 British National Formulary. Sodium Valproate https://bnf.nice.org.uk/drug/sodium-

valproate.html#sideEffects (Accessed 11th February 2020).

24 Harden CL. What Valproate Does and Doesn't Do. Epilepsy Curr. 2004;4(2):59–60.

doi:10.1111/j.1535-7597.2004.42008.x.
25 Neurology MedLink. Epilepsy and women – Sodium valproate.

www.medlink.com/index.php/handout/epilepsy_and_women (Accessed 11th February

2020).
26 Neurology MedLink. Epilepsy and women - Polycystic ovarian syndrome.

www.medlink.com/index.php/handout/epilepsy_and_women (Accessed 11th February

2020).
27 NHS. Polycystic Ovary Syndrome. https://www.nhs.uk/conditions/polycystic-ovary-

syndrome-pcos/symptoms/ (accessed 18 February 2020).

28 National Institute for Health and Care Excellence. Bipolar disorder: assessment and

management. Clinical Guidance 185. London: National Institute for Health and Clinical
Excellence. Para 1.10.27.
29 British National Formulary Sodium Valporate https://bnf.nice.org.uk/drug/sodium-

valproate.html#cautions (accessed 18 February 2020)

30 National Institute for Health and Care Excellence. Bipolar disorder: assessment and

management. Clinical Guidance 185. London: National Institute for Health and Clinical
Excellence. Para 1.10.30 and 1.10.33.
31 British National Formulary. Lamotrigine.

https://bnf.nice.org.uk/drug/lamotrigine.html#sideEffects (Accessed 11th February 2020).

32 National Institute for Health and Care Excellence. Bipolar disorder: assessment and

management. Clinical Guidance 185. London: National Institute for Health and Clinical
Excellence. Paras 1.10.13, 1.10.25, 1.10.35 and 1.10.39.
33 British National Formulary. Interactions Lithium.

https://bnf.nice.org.uk/interaction/lithium.html (Accessed 11th February 2020).

34 British National Formulary. Interactions Lamotrigine.

https://bnf.nice.org.uk/interaction/lamotrigine-2.html. (Accessed 11th February 2020).

35 British National Formulary. Interactions Valproate.

https://bnf.nice.org.uk/interaction/valproate.html (Accessed 11th February 2020).

36 British National Formulary. Interactions Lithium.

https://bnf.nice.org.uk/interaction/lithium.html (Accessed 11th February 2020).

37 British National Formulary. Interactions Valproate.

https://bnf.nice.org.uk/interaction/valproate.html (Accessed 11th February 2020).

38 British National Formulary. Interactions Lamotrigine.

https://bnf.nice.org.uk/interaction/lamotrigine-2.html. (Accessed 11th February 2020).

39 National Institute for Health and Care Excellence. Bipolar disorder: assessment and

management. Clinical Guidance 185. London: National Institute for Health and Clinical
Excellence. Paras 1.10.2.
40 National Institute for Health and Care Excellence 2015. Clinical Guidance 192.

Antenatal and postnatal mental health: clinical management and service guidance.
London: National Institute for Health and Clinical Excellence. Para 1.4.34
41 Medicines and Healthcare products Regulatory Agency. Patient Guide: What women

and girls need to know about valproate.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment
_data/file/860760/Patient-booklet.pdf (Accessed 11th February 2020).
42 National Institute for Health and Care Excellence. Bipolar disorder: assessment and

management. Clinical Guidance 185. London: National Institute for Health and Clinical
Excellence. Paras 1.10.37.
43 National Institute for Health and Care Excellence 2015. Clinical Guidance 192.

Antenatal and postnatal mental health: clinical management and service guidance.
London: National Institute for Health and Clinical Excellence. Paras 1.8.17 and 1.8.19.
44 National Institute for Health and Care Excellence 2015. Clinical Guidance 192.

Antenatal and postnatal mental health: clinical management and service guidance.
London: National Institute for Health and Clinical Excellence. Para 1.8.19.
© Rethink Mental Illness 2014
Last updated February 2020
Next update May 2022

Version 7
This factsheet is available
in large print.